• Journal of Korean Neurosurgical Society
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• 제59권3호
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• pp.322-324
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• 2016

To introduce a new device for catheter placement of an external ventricular drain (EVD) of cerebrospinal fluid (CSF). This device was composed of three portions, T-shaped main body, rectangular pillar having a central hole to insert a catheter and an arm pointing the tragus. The main body has a role to direct a ventricular catheter toward the right or left inner canthus and has a shallow longitudinal opening to connect the rectangular pillar. The arm pointing the tragus is controlled by back and forth movement and turn of the pillar attached to the main body. Between April 2012 and December 2014, 57 emergency EVDs were performed in 52 patients using this device in the operating room. Catheter tip located in the frontal horn in 52 (91.2%), 3rd ventricle in 2 (3.5%) and in the wall of the frontal horn of the lateral ventricle in 3 EVDs (5.2%). Small hemorrhage along to catheter tract occurred in 1 EVD. CSF was well drained through the all EVD catheters. The accuracy of the catheter position and direction using this device were 91% and 100%, respectively. This device for EVD guides to provide an accurate position of catheter tip safely and easily.

• Journal of Mechanical Science and Technology
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• 제15권7호
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• pp.1061-1071
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• 2001

The present study investigated design parameters of shunt valves and anti-siphon device used to treat patients with hydrocephalus. The shunt valve controls drainage of cerebrospinal fluid (CSF) through passive deflection of a thin and small diaphragm. The anti-siphon device(ASD) is optionally connected to the valve to prevent overdrainage when the patients are in the standing position. The major design parameters influencing pressure-flow characteristics of the shunt valve were analyzed using ANSYS structural program. Experiments were performed on the commercially available valves and showed good agreements with the computer simulation. The results of the study indicated that predeflection of the shunt valve diaphragm is an important design parameter to determine the opening pressure of the valve. The predeflection was found to depend on the diaphragm tip height and could be adjusted by the diaphragm thickness and its elastic modulus. The major design parameters of the ASD were found to be the clearance (gap height) between the thin diaphragm and the flow orifice. Besides the gap height, the opening pressure of the ASD could be adjusted by the diaphragm thickness, its elastic modulus, area ratio of the diaphragm to the flow orifice. Based on the numerical simulation which considered the increased subcutaneous pressure introduced by the tissue capsule pressure on the implanted shunt valve system, optimum design parameters were proposed for the ASD.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.437-440
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• 2013

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.301-305
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• 2017

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.534-537
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• 2010

Spinal extradural meningeal cyst has been rarely reported, whose etiologies are assumed to be the communication of cerebrospinal fluid (CSF) between intradural subarchnoid space and cyst due to the congenital defect in dura mater. Although the CSF communication due to this defect can be found, in most case, few cases in which there is a lack of the communication have also been reported. We report a case of the huge extradural meningeal cyst occurring in the thoracolumbar spine (from T10 to L2) where there was a lack of the communication between the intradural subarachnoid space and cyst in a 46-year-old man who presented with symptoms that were indicative of progressive paraparesis and leg pain. The patient underwent laminectomy and cyst excision. On intraoperative findings, the dura was intact and there was a lack of the communication with intradural subarachnoid space. Immediately after the surgery, weakness and leg pain disappeared shortly.

• 대한의용생체공학회:의공학회지
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• 제40권5호
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• pp.189-196
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• 2019

We investigated differences in ventricular and hippocampal volumes between CSF tap test (CSFTT) responders and non-responders in idiopathic normal-pressure hydrocephalus (INPH) patients and compared these parameters in INPH patients with that of age- and gender-matched healthy controls. We also evaluated relationships between ventricular and hippocampal volumes and clinical profiles in INPH patients. We enrolled 48 patients with INPH and 29 healthy controls. Ventricular and hippocampal volumes were measured on MRI, including 3-dimensional volumetric images. INPH patients, when compared to healthy controls, had significantly larger ventricular and smaller hippocampal volumes. No difference in ventricular and hippocampal volumes was found between CSFTT responders and non-responders in INPH patients. And hippocampal volumes showed significant negative correlations with Clinical Dementia Rating Scale scores, INPH grading scale cognitive scores, Timed Up and Go Test scores, and Unified Parkinson's Disease Rating Scale motor scores in INPH patients. Volumetric assessment of ventricular and hippocampal regions may have no predictive value in differentiating between CSFTT responders and non-responders in INPH patients. Our findings may help us understand the potential pathophysiology of unique symptoms associated with INPH.

• 대한영상의학회지
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• 제85권1호
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• pp.24-35
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• 2024

자발두개내압저하(spontaneous intracranial hypotension)은 기립성 두통을 특징으로 하는 질환이며, 영상기법의 발달과 질환에 대한 인식이 높아짐에 따라 발견 빈도가 점차 증가하고 있는 추세이다. 이전에는 이 질환에서의 특징적인 뇌 자기공명영상 소견들이 많이 알려져 있었다. 그러나 최근에는 척추에서의 뇌척수액 누출이 원인으로 알려짐에 따라 척추 자기공명영상 소견이 주목받고 있다. 또한 뇌척수액 누출 부위를 정확히 확인할 수 있는 초고속 CT 척수조영술(ultrafast CT myelography), 디지털 감산 척수조영술(digital subtraction myelography) 등이 개발되었다. 이 종설에서는 자발두개내압저하의 진단, 척추 자기공명영상 소견, 최신 영상검사법과 치료에 대해 다루고자 한다.

• 한국방사선학회논문지
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• 제15권6호
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• pp.927-933
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• 2021

본 연구에서는 mDixon 기법과 T2 TSE, T2 SPIR 기법을 비교하여 3번 허리뼈 체부, 등 지방, 척수, 뇌척수액 위치에서 검사 시간, 신호대잡음비, 대조도대잡음비의 차이를 알아보고자 하였다. 성인 30명을 대상으로 신호대잡음비에 영향 인자를 고정하고 요추 시상면을 mDixon검사와 T2 TSE, T2 SPIR 검사를 한 후 비교하였다. mDixon의 검사 시간은 115초, T2 TSE는 60초, T2 SPIR는 60초였다. mDixon T2영상은 T2 TSE 영상보다 3번 허리뼈 체부에서 신호대잡음비가 높았고, 등 지방과 뇌척수액에서는 SNR이 낮았으며(p<0.05), 척수에서는 비슷한 신호대잡음비을 가졌다(p>0.05). 3번 허리뼈 체부와 등 지방의 대조도대잡음비는 mDixon T2영상이 높았으며, 뇌척수액과 척수의 대조도대잡음비는 T2 TSE가 높았다(p<0.05). mDixon T2 FS영상은 T2 SPIR영상보다 3번 허리뼈 체부, 등 지방에서 낮았고, 척수, 뇌척수액에서는 높았다(p<0.05). 3번 허리뼈 체부와 등 지방의 대조도대잡음비는 mDixon T2 FS영상이 높았으며(p<0.05), 뇌척수액과 척수의 대조도 대잡음비는 두 영상이 차이가 없었다(p>0.05). mDixon 기법이 기존의 T2 TSE, T2 SPIR 기법에 비해 검사 시간, 각 부위의 신호대잡음비, 대조도대잡음비에서 보다 우수한 영상이라 하기 어려웠다. 하지만 본 연구는 단순 요추통증환자를 대상으로 제한하였다는 한계로, 기존의 연구에서 보고된 금속물 삽입, 척추 종양, 골절 환자 등 특정 환자군의 설정을 통한 추가 연구들이 필요할 것으로 사료된다.

• 대한임상검사과학회지
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• 제45권1호
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• pp.37-42
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• 2013

The cells are concentrated approximately 20-fold by cytocentrifugation. This study evaluated the nucleated cell number for cells recovered on slide by using Cytospin-3 (Thermo Shandon Ltd. UK) and Cytopro-7620 (Wescor Inc., USA) cytocentrifuges to hematocytometer cell count of $0{\sim}5WBCs/{\mu}L$ of hematocytometer in the cerebrospinal fluid cell count. One hundred forty eight samples of $0{\sim}5WBCs/{\mu}L$ on hematocytometer, were cytocentrifuged by Cytospin-3 and Cytopro-7620 instruments. The nucleated cell number for cells recovered on slide was counted after Wright stain. The nucleated cell number for cells recovered on slide was 0~40 cells in the 44 samples of $0WBC/{\mu}L$, and 3~95 cells in the 31 samples of $1WBC/{\mu}L$. It was observed that the nucleated cell number for cells recovered on slide was 13~100 cells in the 44 samples of $2WBCs/{\mu}L$, and more than 100 cells in the 29 samples of $3{\sim}5WBCs/{\mu}L$, respectively. In addition, extremely normal lymphocyte, monocyte and polymorphonuclear neutrophil were observed in the 143 samples of $0{\sim}5WBCs/{\mu}L$. Macrophage and eosinophil were also rarely observed. The nucleated cell number for cells recovered on slide was 20 cells, which were regarded as $1WBC/{\mu}L$ in body fluid cell count. However, in this study, we made alterations to report nucleated cell percentage as 0% without preparing the cytocentrifuged slide at $0WBC/{\mu}L$ by using the cell yield in a comparison between the value of $0{\sim}5WBCs/{\mu}L$ and nucleated cell number for cells recovered on slide.

• 한국전산유체공학회지
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• 제6권1호
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• pp.40-46
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• 2001

Pressure-flow control characteristics of a commercially available cerebrospinal flow(CSF) control shunt valve was studied using flow/structure interaction analyses. Pre-stress of the valve diaphragm(membrane) was accounted for the simulation of an actual valve. The present results were in good agreement with the valve specification listed in the commercially available CSF control valve. The flow/structure interaction analysis of the present study can be effectively used to design a variety of CSF control shunt valves.